If you are suffering from erectile dysfunction as a result of an underlying health condition, you’ll usually need to treat the underlying condition first, before you embark upon a course of treatment for impotence. You may then find that by treating the underlying condition, this solves the problem of your erectile dysfunction too. Speak to your doctor about the fact that you are struggling with ED as well as your underlying condition, so that they can factor this into your treatment plan.

If you are taking medication for another condition and you think that this is causing erectile dysfunction, have a chat with your doctor about it. It may be that they can suggest an alternative type of medication. Make sure that you talked to your doctor or healthcare professional before you stop taking any medication that you’ve been prescribed.

Psychological Treatment Options

Counselling can be very helpful for people who have erectile dysfunction that is caused by psychological problems like anxiety or depression. Another type of treatment for people who have ED that has a psychological cause is called Sensate Focus.

Sensate focus is a type of sex therapy. You and your partner agree not to have sex for a set period of time. During this time, you can still touch each other, but you agree not to touch each others’ genitals (or a woman’s breasts). During the agreed timeframe, you then set aside time to spend together as a couple to explore each others’ bodies without having sex. Clothed or naked, you can massage each other, explore touch, and stroke each other. Once the agreed timeframe has passed, you can then start to touch each others’ genitals, you can start to use your mouth as a way of exploring each others’ bodies through kissing or licking your partner, for example. Gradually, you can then build up to penetrative sex together. If you would like to read a bit more about Sensate Focus or about sex therapy in general, the College of Sexual and Relationship Therapists website is very useful: /www.cosrt.org.uk/information-for-members-of-the-public/tips-for-sexual-wellbeing/

Psychosexual counselling is a talking therapy. It has mixed results and can take a while to work, but many people find it really helps. It provides space for you and your partner to talk about any issues that might contribute to or cause your erectile dysfunction. The aim of talking it through is to help you feel less worried or anxious, so that you can overcome your problems. The counsellor can also offer advice on sex, like practical foreplay techniques and how you might like to incorporate other treatments for erectile dysfunction into your plans to improve your sex life. The NHS offers advice on good sex which includes practical tips on arousal. You can read this on the NHS website: /www.nhs.uk/LiveWell/Goodsex/Pages/Goodsexhome.aspx

Cognitive Behavioural Therapy can also be helpful in treating impotence. Cognitive Behavioural Therapy explores the link between the way we think and how we feel. It aims to change the way you think about and react to a situation, to help you feel happier. A CBT therapist can work with you to identify factors that are contributing to your erectile dysfunction. They will look for unhelpful thoughts or thought patterns that might be linked to: your self esteem, your sexuality or your personal relationships. With the therapist, you can then work to change these by practicing different ways of thinking.

Complementary therapies

Like acupuncture claim to improve impotence. The evidence of whether this is effective is limited. If you decide to try to treat your erectile difficulties with complementary therapies, speak to your doctor first because sometimes they can interact with other medicines.

Pelvic Floor Muscle Exercises

The pelvic floor muscles are grouped under the bladder, around the rectum and at the base of the penis. The exercises strengthen and train the muscles used to urinate and to control the anus (back passage). There is some evidence to suggest that for some people, exercising these muscles can improve erectile dysfunction. If you think this might help you, have a chat with your GP who might refer you to a physiotherapist so that you learn how to do the exercises correctly.

The vacuum pump

A vacuum pump is made up of a clear plastic tube connected to a hand or battery activated pump. You put your penis into the tube and pump out all of the air. This increases the blood flow to your penis so that you can get and sustain an erection. You then put a rubber ring around the base of your penis to keep the blood there. Using this, you will be able to sustain an erection for about 30 minutes. It can take a bit of practice to get used to using the pump properly, but 90% of men who used it found that they were able to sustain an erection (regardless of the cause of their impotence).

Cautions

You shouldn’t use the vacuum pump if you have a bleeding disorder or take anti-coagulant (blood thinning) drugs. Under a third of people find that they experience side effects of pain or bruising using the pump. If you qualify for erectile dysfunction treatment on the NHS, then you might also be able to get a pump, but normally most people have to buy their own. You can get advice on using pumps and other topics from the Sexual Advice Association: /www.sda.uk.net/advice.php

Alprostadil

If you find that your erectile dysfunction is not responding to your course of treatment, or if you can’t use Viagra, Cialis, Levitra or the vacuum pump, then your doctor might suggest you try Alprostadil (a synthetic hormone that increases the flow of blood to the penis given either as injection into the penis or as a pellet placed inside the urethra). You can be trained in how to inject or insert the pellet of Alprostadil. It usually takes effect within five to fifteen minutes. The length of time that the erection lasts for varies with the dose. If your partner is pregnant, you’ll need to use a condom during sex.

Alprostadil when placed in the urethra is effective in 2 out of 3 men with ED. Alprostadil injections worked for just over 8 out of 10 men who found that Viagra, Cialis and Levitra didn’t work for them.

Treatments Available

About Cialis

The weekend pill

Cialis from Lilly pharmaceutical company is sometimes known as The Weekend Pill.

Cialis has been licensed in the UK for over a decade. It was the second erectile dysfunction (ED) prescription medication of its type to receive a UK license, after Viagra (sildenafil). Its prolonged duration of action and the option to take a low dose daily tablet have led to Cialis becoming increasingly popular and being more widely prescribed.

Daily versus Cialis '36 hours'

Most men take Cialis as and when they need it, usually 10mg or 20mg, which is effective for up to 36 hours.

Men who need erectile dysfunction treatment two or more times a week should consider taking a regular low dose Cialis tablet daily. Cialis 2.5mg or 5mg tablets taken every day will provide continuous erectile dysfunction treatment, without peaks and troughs.

What does it do?

Cialis contains tadalafil which is known medically as a PDE5 inhibitor. Tadalafil inhibits the PDE5 enzyme which is involved in regulating blood flow in the penis during erections. Sexual stimulation is required before the medication will work and without it Cialis will have no effect. Cialis augments and supports sexual performance and relationships.

Cialis can also be used to treat benign prostatic hyperplasia (enlarged prostate) symptoms.

Why do men get erectile dysfunction?

A range of factors contribute to erectile dysfunction, including lifestyle choices, mental state, chronic disease, and injuries and operations. Emotional problems, such as stress and performance anxiety, can have an impact on both erectile performance and sexual desire. Occasional treatment with a PDE5 inhibitor such as Cialis can be effective in breaking a cycle of anxiety and failure. Lifestyle factors, such as smoking, non-prescription drug use, excessive drinking and even obesity can have an effect. Erectile dysfunction is sometimes a symptom of underlying health problems such as diabetes, atherosclerosis and heart disease, amongst others.

Men suffering from erectile dysfunction should inform their GP who will undertake an assessment, possibly perform tests, and provide advice.

Why Cialis?

Cialis benefits from having a long duration of action. Viagra remains active for about 4 hours, Levitra for 4-5 hours and Cialis for 36 hours – hence its familiar name 'The Weekend Pill'. Erections will not be continuous during 36 hours after taking Cialis, occurring only at times of arousal during those 36 hours.

Taking Cialis for the first time

There are four strengths of Cialis – 2.5mg, 5mg, 10mg and 20mg. The lower doses of 2.5mg and 5mg are primarily for regular daily use, although Cialis 5mg strength can be taken on an as required basis by men who respond well to one-off lower doses.

The usual starting dose is 10mg taken at least 30 minutes before sexual activity. If this dose is highly effective, subsequent doses could be reduced to 5mg on a trial basis. If repeated trials of a 10mg dose prove ineffective, the dose can be increased to 20mg.

There is no benefit in taking a higher dose than is needed. Repeated trials of treatment at one dose are recommended before changing to higher or lower strength tablets.

All men who are troubled by erectile dysfunction, which can be a distressing problem, should consult a doctor for a full assessment and advice.

Side effects of Cialis

Most men taking Cialis do not experience significant side effects. A full list of the most frequent side effects can be found in the manufacturer's patient information leaflet supplied with Cialis tablets (links below).

Some men experience a bluish or yellowish tinge to their vision after taking Cialis. This is not dangerous and fades after a few hours time. This is a possible side effect of all ED drugs (PDE5 inhibitors).

Other common side effects (affecting 1%-10%) include headache, back pain, muscle aches, pain in the arms or legs, nasal congestion, facial flushing, and indigestion.

On very rare occasions ED treatment produces prolonged and painful erections, in a condition known as priapism. Priapism is a medical emergency with the potential on rare occasions for irreversible injury to the penis. If an erection lasts for more than 4 hours, medical attention should be sought immediately.

When not to take Cialis

During an assessment on the Dr Fox web site, men are required to complete an erectile dysfunction questionnaire. This determines if Cialis is suitable. Men should not take Cialis without further assessment from their GP if any of the following apply: